Endoscopic Ultrasound Guided Drainage Of Patients With Infected Walled Off Necrosis: Which Stent To Choose?

Aims We aimed to compare clinical outcomes of endoscopic ultrasound (EUS) guided drainage procedure using biflanged metal stents (BFMS) or double pigtail plastic stents (DPPS) amongst patients with pancreatic fluid collections and subgroup with infected walled off necrosis (WON).

Methods Between Jan 2018 to Dec 2019, consecutive patients with symptomatic PFC subjected to EUS guided drainage using biflanged metal stents (BFMS) or double pigtail plastic stents (DPPS) were compared for technical success, clinical success, duration of procedure, need for ICU stay, duration of ICU stay, ventilator need, resolution of organ failure, duration for resolution of organ failure, need for necrosectomy, need for salvage percutaneous drainage, complications, need for surgery and mortality. A subgroup of patients having infected WON were also analysed separately.

Results Among 130 patients (84.6 % males) with PFC (108 WON, 22 pseudocyst) who underwent EUS guided drainage, there was no difference in outcome parameters in BFMS and DPPS groups in the entire cohort. Amongst patients with WON, clinical success was significantly higher (93.7 % vs 80 %, p = 0.039), duration of hospital stay (5 days vs 10 days, p = 0.028) and duration of procedure significantly lower (15.94±7.2 minutes vs 42.40±11.2 minutes, p =  0.0001) in BFMS compared to DPPS group. Amongst patients with infected WON the duration of procedure was significantly lower (15.36±6.8 vs 40.56±10.0, p =  0.0001) and there was a trend towards higher clinical success in BFMS compared to DPPS group (90.9 % vs 73.9 %, p = 0.243) On multivariate analysis, use of BFMS for drainage was found to be a positive predictor [OR- 4.36, (p = 0.034), CI: 1.12 – 12.01] whereas WON having a solid component > 40 % [OR-0.20, (p = 0.002), CI: 0.05 – 0.79] was a negative predictor for clinical success.

Conclusions EUS guided drainage in WON using BFMS scores over DPPS. In patients having infected WON, BFMS may be preferred over DPPS.

Citation Muktesh G, Samanta J, Dhar J et al. eP419 ENDOSCOPIC ULTRASOUND GUIDED DRAINAGE OF PATIENTS WITH INFECTED WALLED OFF NECROSIS: WHICH STENT TO CHOOSE? Endoscopy 2021; 53: S233.

Publication History

Article published online:
19 March 2021